move, breathe, succeed!
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Move, Breathe, Succeed!. Matheny Medical & Educational Center. - PowerPoint PPT PresentationTRANSCRIPT
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Matheny Medical & Educational Center
Matheny’s main campus is located in Peapack, NJ. Matheny is home and school to 101 adults and children with developmental disabilities. In addition to their primary diagnoses many children and adults, have a long list of associated clinical conditions such as vision and hearing deficits, seizure disorders, cognitive impairments and dysphagia, with resulting aspiration problems.
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About Matheny
Middle States accredited school JCAHO and CARF accredited School and
Hospital Multidisciplinary team approach
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Brynna 3 years of experience with the
developmentally disabled population Speech Pathologist at Matheny Medical
and Educational Center Certifications and Licensure
New Jersey State Speech Language PathologistNew Jersey Board of Education Speech
Language SpecialistAmerican Speech Language Hearing
Association Certificate of Clinical Competence
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Christine
11 years of experience with the developmentally disabled population
Senior Speech Pathologist at Matheny Medical and Educational Center
Certifications and Licensure New Jersey State Speech Language Pathologist New Jersey Board of Education Speech Language Specialist American Speech Language Hearing Association Certificate of
Clinical Competence Rehab Engineering Society of North America certified Assistive
Technology Professional Certified Pediatric Neuro-Developmental Treatment therapist PROMPT trained
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Erin 10 years of experience with the
developmentally disabled population Physical Therapist at Matheny Medical
and Educational Center Certifications and Licensure
New Jersey State Physical TherapistNew Jersey Board of Education School
Physical TherapistCertified Pediatric Neuro-Developmental
Treatment therapist
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The Rule for Today
Every time you hear the word ‘movement’, stand all the way up, then sit down.
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Why is respiration important
The process of Respiration: Diaphragm contracts &
moves down Ribcage expands in 3
directions as lungs fill with air
Diaphragm relaxes, the ribcage contracts, expelling air from the lungs
The function of respiration: Getting oxygen to the
tissues and organs of the body
Removes carbon dioxide/waste
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How respiration is important in daily functioning
Gives endurance Feeds brain cells Promotes better health Promotes improved attention Necessary for everything!
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The Basics-Anatomy of the ribcage
Structure Cage like part of the
body comprised of bones, muscles and cartilage
Function Protect the internal
organs such as lungs, heart, kidneys, liver
Additionally, it supports the head, neck and upper extremities
Brynna Cunningham, M.S., CCC-SLPChristine Mayercik, M.S., CCC-SLP, ATP, C/NDT
Erin Meineke, PT, DPT, C/NDT
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Structure-Bones
• Bones– 12 pairs of ribs, with origin at the
thoracic vertebrae and insertion at the sternum.
– Ribs 1-7 are known as “True” Ribs, meaning they have individual origins and insertions
– Ribs 8-10 are known as “False” Ribs, meaning they have unique origins on the vertebrae, but articulate with rib #7 at the sternum
– Ribs 11 and 12 are known as “Floaters”…they have origins on the vertebrae, but do not connect to the sternum.
– The sternum is comprised of three parts…the manubrium, the body and the xyphoid process. Ribs attach to the manubrium and the body, but not to the xyphoid process.
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Structure-Muscles and Cartilage
• Muscles and cartilage• Intercostals…in the space
between ribs. On inhalation, the intercostals contract, lifting the ribcage up and out.
• Sternocleidomastoid, Scalenes, Pectoralis…assist in respiration by lifting the ribcage.
• Diaphragm…forms the base of the rib cage. On inhalation it flattens and contracts, pulling the lungs down and allowing them to fill.
• Cartilage connects the true ribs to the sternum. It allows movement of the ribs during inhalation and exhalation.
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The Diaphragm
The muscle that forms the floor of the ribcage. Maximizes inhalation Contributes to postural
control Supports gastro-
intestinal function Aids venous return
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Movement of the Ribcage
Typical During respiration, the
ribcage moves in 3 planes:○ Up/down (vertical)○ Front/Back
(anterior/posterior)○ Around (Transverse)
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Movement Break!
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Normal rib cage development
• Infant ribcage:– Triangle shape– Whole cage is elevated
and ribs are horizontal – High respiratory rate and
low tidal volume– Diaphragmatic nose
breatherMassery, M. 1994
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Normal ribcage development
• 3-6 months– anterior chest wall
significantly opens– Ribcage configuration
begins to look more rectangular
– Respiratory rate decreases as tidal volume increases
6-12 months Child is now upright against
gravity Breathing is no longer
posturally inhibited by contact with supporting surface
Gravity and developing abdominal muscles rotate the ribs and begin to pull them downward which results in an elongated chest wall
12 months + Downward rotation of ribcage
continues
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Typical Breathing Patterns
Normal Breathing PatternsClavicularThoracicDiaphragmatic
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Typical Breathing-Toddler
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Typical Breathing- 5 year old
Bench sitting Supine
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The Basics- Atypical development
How we end up with kids who are not breathing well
Muscle tone Neurological
impairment Physical abnormalities
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Atypical Ribcage Development
What we see: Decreased head and neck
control
Poor Control of Shoulders and Upper Extremities
Poor Control of Pelvis and Lower Extremities – due to low tone
Poor Control of Pelvis and Lower Extremities – due to high tone
Effect on Respiration: Open mouth positioning Increase thoracic kyphosis (flexion) and lumbar flexion Decreased oral motor control – baby is unable to bring
hands to mouth Scoliosis
Increased thoracic kyphosis
Rib flaring Poor rib cage and intercostal movement – the rib cage
moves as a whole unit to produce body movement, movement occurs between T12-L1 spinal segment
Increased thoracic flexion in sitting
Decreased use of abdominal obliques, which become elongated and weak
Increase in thoracic and lumbar flexion Fixing with rectus abdominis which can contribute to rib
flaring
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Atypical Breathing Patterns
ParadoxicalDiaphragm and upper accessory musclesUpper accessory musclesAsymmetricalLateral or gravity eliminatedShallowRib FlareNon-rhythmical breathing
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Atypical Breathing Patterns
Rib Flaring Minimal ribcage movement
S/P Spinal stabilization
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Other Factors Impacting Respiration Posture Position GERD Asthma Genetic conditions Vents, trachs,
intubation Scoliosis Spinal Stabilization Other surgeries
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The effects of Posture
• A chronically slumped posture can lead to kyphotic posture– Shortened anterior ribcage
wall, shortened rectus abdominus,
– Forward head position– Shoulders are elevated and
adducted(protracted scapula and internally rotated humerous)
– Accessory muscles are not available to aid in respiration
– Posterior pelvic tilt
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The effects of positioning
Sitting positioning Slumped posture Head position Lateral leaning Pelvic tilt Visual issues Body awareness Lacking the ability or
understanding to reposition themselves
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Improved respiration=Improved health
Respiratory problems are some of the sequela of neurological diagnoses, causing excessive loss of work or school days and numerous hospitalizations
Massery, M., 1994
Maintaining a healthy respiratory status should be a top priority for a neurologic population.
Massery, M., 1994
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How to improve respiration
Introduce movement Setting up the classroom/or day
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There is some evidence that physical exercise improves mental sharpness
“What’s happening in the body is their heart rate is increasing and blow flow is changing, and they’re actually activating the brain differently than when they are sitting down”
○ John Ratey, Harvard University
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Support for Movement Breaks
“In 2008, the U.S., Dept of Health and Human Services issued physical guidelines for Americans ages 6 and older. These guidelines recommend that children and adolescents participate in 1 hour or more of physical activity daily. Physical Activity should take place throughout the day to meet this recommendation.”
National Association for Sport and Physical Education
“Physical activity improves general circulation, increases blood flow to the brain, and raises levels of norepinepherine and endorphins-all of which may reduce stress, improve mood, induce a calming effect after exercise, and perhaps as a result improve achievement.”
Taras, H., 2005
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More support
According to Betts, et al. (2006), elementary school students’ sustained attention is not fully developed. They suggested that elementary students need breaks during their school day because they cannot stay focused for extended periods of time
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Benefits of Movement Breaks and Respiration
Children are often more attentive, behave better, and perform as well or better scholastically after participation in physical activity through recess or physical education.
Mahar, M., et al, 2006
Because of budgetary constraints and growing pressure on administrators and teachers to increase academic achievement scores, opportunities for physical activity are being reduced or eliminated.
Mahar, M., et al, 2006
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Movement Break!
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Its easy to make changes
Easy, fast, brief Get it into your day
with minimal disruption Fun and motivating Make it something
everyone can do
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Suggestions of activities
Busy City Get Up and Move Over/Under Relay
Benefits: Communication Social skills/awareness Sensory/Spatial awareness Creativity Increasing respiration!
Other resources 10 simple activities to
encourage physical activity in the classroom○ www.YourTherapySource.com
Integrating Physical Activity into the Complete School Day○ www.naspeinfo.com
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Ways to introduce movement
Pairing movement with respiration
Movement breaks in the classroom
Alternate positioning Short yoga breaks Incorporating more
reaching tasks into lessons
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What we came up with
Respiratory boxes: One per classroom A bag for each student Some items are shared
by the class
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Respiratory Boxes
Some ideas:
Have contests to see who can make the loudest noise, longest noise, most attempts at noises, etc.
Keep track and see if you can do better than your last attempt.
Use the magic mics to participate in short songs: staff sings/speaks a line and allows each student to finish it (any vocalization is acceptable here), kind of like playing karaoke. Let students pick songs out of a hat by reaching to the sides or diagonally to get to the hat.
Bubbles: See how many bubbles you can blow initially. Have contests to see who can blow the most, biggest, etc. Try to blow more at the end of respiratory play. Between the first attempt and last attempt, have students help by dipping the wand, grabbing paper towels to dry hands, etc. Have students reach in every direction (up, down, across body, out to the sides, etc), especially laterally.
Pinwheels: See who can get theirs going fastest, longest, or most often. Between first attempt and last attempt, have students pass the pinwheels around the circle by reaching laterally to their friends. Play games where one person starts, and when they stop, the next person starts.
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Video of 301
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Your turn!
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Questions
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References Aubrey, A. Deskercise: Staying Jazzed and Focused at School. 2009.
www.npr.org/templates/story/story.php?storyID=101149470 Bly, L. (2011). Components of Typical and Atypical Motor Development. Laguna
Beach, CA: NeuroDevelopmental Treatment Association, Inc. Bachman, J.E. and Fuqua, R.N. Management of Inappropriate Behaviors of Trainable
Mentally Impaired Students using antecedent exercise. Journal of Applied Behavioral Analysis, vol. 16, No. 4, pp. 447-484, 1983.
Dwyer, T., Sallis, J.F., Blizzard, L., Lazarus, R. and Dean, K. Relation of Academic Performance to Physical Activity and Fitness in Children. Pediatric Exercise Science, Vol. 13, pp.225-237, 2001.
Eddy, M. Movement in the Classroom. www.wellnessCKE.net. Move for Health of Body and Mind.
Kerby, A. Effects of Breaks on Elementary Students’ classroom Behaviors (master’s thesis). St. Mary’s College of Maryland.
Mahar, M.T., Murphy, S.K., Rowe, D.A. , Golden, J., Shields, A.T. and Thomas, D.R. Effects of a Classroom-Based Program on Physical Activity and On-Task Behavior. Med. Sci. Sports Exerc. Vol. 38, No.12, pp. 2086-2094, 2006.
Massery M. Multisystem clinical implications of impaired breathing mechanics and postural control.
In: Frownfelter D, Dean E, eds. Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice. 5 ed. St. Louis, MO: Elsevier-Mosby; 2012:633-653.
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References Massery M. Asthma: Multi-System Implications. In: Campbell S, Palisano R, Orlin M,
eds. Physical Therapy for Children. 4 ed. St. Louis, MO: Elsevier; 2012:815-844. Massery, M., Breathing and Upright Posture: Simultaneous Needs, in 26th
International Seating Symposium, Vancouver, BC. March 11-13, 2010;25-28. Massery M. The patient with multi-system impairments affecting breathing mechanics
and motor control. In: Frownfelter D, Dean E, eds. Cardiovascular and Pulmonary Physical Therapy Evidence and Practice, ed. 4. St. Louis, MO.: Mosby & Elsevier Health Sciences; 2006:Chapter 39:695-717.
Massery MP. What’s positioning got to do with it? Neurology Report. 1994;18(3):11-14. Schroeder, R. Importance of Respiration.
www.ehow.com/about_5390615_importance-respiration.html Taras, H. Physical Activity and Student Performance at School. Journal of School
Health, Vol. 75, No. 6, pp. 214-218, 2005. Winslow, K.C. Movement Activities for the Classroom.
www.ehow.com/print/info_7871679_movement-activities-classroom.html Integrating Physical Activity Into the Complete School Day. www.naspeinfo.org 10 Simple Activities to Encourage Physical Activity in the Classroom. 2001.
www.therapysource.com
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